Hands

[smallworld]

Hi,

I'm not sure how to explain this, but I'll give it a go...

My son (5 and asd) looks quite awkward in that his hands look like they are cramped with fingers going in different directions. They're not stiff, quite the opposite, he's very bendy, but when he's walking his fingers are pointing out but not in the same direction.

Is this a feature of asd ? (or is this a daft question ? !!)

He cannot hold a pencil with a secure grip and has very poor fine motor skills (except with scissors!). We have asked for an OT assessment but his paed. thinks that his problems are all part of his asd and he just needs to practice more. His school are desperate for help with this and are pushing for an OT assessment, asking me to make waves too. He is excellent with ball skills and is very agile, with good balance so I can't see dyspraxia in him.

His lunchtime support also supports a child in nursery with far more severe asd and remarked that my son looks more obviously autistic. I know what she means by this.

None of the other asd kids I know do this, it's very different to finger flicking (someone said to me that he looks like a child with CP and I can see this myself )

Any ideas ?

I need help to pursue this OT assessment, and would like to know if this hand 'thing' is another facet of his asd. ?

 

wac

Edited October 12, 2005 by waccoe

[smallworld]

I hope no-one minds me bumping this up, but I'm off to parents' evening tomorrow and I'd like to discuss the need for an OT for my son.

I know very little about OT, so would be grateful for any replies on the 'hands' issue,

 

wac

[Malika]

Hi waccoe

 

Just had a discussion with my GP this morning about my son OT assesment which I think was not done properly because no real tests were made showing his sensory motor integration PBS. My GP did not seem to click on.

I remembered afterward that my rapresentative from IPSEA told me that here the "sensory motor integration" staff is considered an american thing and not taken very seriously here except for few professionals. Getting better mind!!

Bear in mind that what you describe could be as well a feature of Fragile X has your son been tested for it?

 

Here some links which may be useful..hopefully.

 

http://www.fragilex.org/html/home.shtml

 

http://www.autism.org/si.html this one is about sensory.

 

Malika.

[elainem]

hi sorry this is quick, very busy twin birthday morning! one of my twins age 5 has dx of ASD but he is also v. dyspraxic. he has extremely poor pencil grip and find motor skills. we had a private o/t assessment has waiting list here is 2.5 years. however we have also asked the NHS to fund the private therapy, they cosidered and said no - but they have asked the OT NHS team to do an assessment on M - might not lead to therapy any earlier, but who knows. The private OT is not cheap - assessment was �350 and each hour consultation �75 so we are having only limited therapy. we have a programme we do at home. we are also going to be using a handwriting programme called handwriting without tears - LEA have funded this and in-service training for the TA by the OT so pleased about that. We are doing some basic handwriting exercises as part of the therapy - to develop pencil grip, strengthen finger muscles, and pencil group. have been seeing some small improvments. If you want me to tell you the exrecises let me know. Def see your GP for a referall, ask what the waiting time is. If you can afford it and waiting time to long go for private as these early years are important - I heard it's important to have intervention before age 7? sorry if long and waffly. email me if you want to.

 

Elaine

[smallworld]

That's great, thanks Malika and Elaine

I thought there must be something available from OT specifically for strengthening hands and improving fine motor skills.

My son's fragile x test came back negative, but I will certainly look into Sensory motor integration. Watching him over the last couple of days, I think he may like the sensation he gets from streching his fingers out so wildly, he also does it mainly when walking. Just need to work out why !!

Thanks again, I won't feel quite so clueless as to what I'm supposed to be fighting for with this OT thing at parents' evening

Have just been to my 9 yr old's (undx as) parents 'lunchtime', the class teacher (also SENCO) said so far she had decided my son was 'in his own world', 'passive' ,'sullen' and 'with a bit of an attitude' but she would give him the benefit of the doubt !!

She hasn't realised that he's actually terrified of her cos she shouts so much !!

She also doesn't think that he has any problems at school.....

 

wac

[call me jaded]

This does sound dyspraxia-ish.

 

Ask for an OT referral via your GP. The NHS have targets for referral times, so you will be seen quicker than via the ed psych. The criteria for assessment may have a cut-off age (ours is 7) so that may be a factor too.

[elainem]

The NHS have targets for referral times

 

Hi Jaded,

 

re the above statement, try as I might I cannot find out the above information and our waiting list is 2.5 years - do you know where I might be able to get hold of the standard.

 

Thanks in advance. (sorry to hijack your thread Waccoe)

 

Elaine

[smallworld]

That's ok Elaine, Jaded's post was very interesting, I had no idea that it would be quicker for our GP to refer.

Thanks for that info Jaded,

 

wac

[smallworld]

Hi,

Have been looking up sensory motor integration, not much to read from the UK (unless you're into robotics !!)

In my son's infant school, all children do brain gym every day, from what I've read so far this a particular bonus for my son.

I've looked at his handwiting in his folder at school and you can see that he is trying to follow the underlying yellow writing done by the LSA, but if you took this away it would be totally unrecognisable as handwriting.

So we're off to fight another battle to access over-stretched services.

 

wac

[Malika]

HI waccoe

 

Just few tips about hand grip for ASD children my one is doing some written exercise writing on the reverse of a mouth pad to learn not to put too much pressure as this would make a hole in the paper, another one is to collect little coin 1p or 5 p from inside a ball of plasticine then put them in a box one by one sliping themfrom inside the hand to the thumb /index grip then put them back one by one into the plasticine (if the coin are too small let him do it with bigger one) and as well just to ask him to get hold of some plasticine and to try to push his finger inside one by one or in a grip with his thumb.

In my area they do not accept referal to OT from the school anymore and you must go through you GP to get one there is 1 year waiting list but sometimes you get through quicker if the GP insist.

 

There is some kind of plasticine call patty for OT exercise did not bought it found it quite expensive if I wanted the quantity required and decided to work with normal plasticine.

 

I found that exercises are useful to remediate sensory prbs as may be it helps the brain to built some connection that may be weak or missing (well this may not be right scientificaly any idea about this??)

 

Hope this will help.

 

Malika.

[call me jaded]

I was given that advice off the record by a clinical psychologist - he led me to believe that's true for all referrals. Thinking about it I'm not sure if OT has the necessary status to count. I've had a look at the website for OTs but the link to waiting times data was broken. I'll see if they respond to my email next week.

[Zemanski]

I find blutac (the white version is softer and stretchier) is nearer the OT putty than plasticine - there are lots of fine motor things to do with it - stretching it out, rolling into snakes and snails, pinching points to make a spiky ball ....

 

anything that requires finger manipulation and accuracy rather than whole hand is excellent exercise - get some of those mini pegs, pick up one at a time with just the thumb and finger and place along an edge - we keep them in a plastic beaker and use the edge of the beaker. you could also hang things from a line with them - helping hang the washing with real pegs or hang christmas cards or artwork.

sorting beads, counters etc, again using thumb and forefinger

threading buttons and beads

making chains from paper clips

putting an x in squares on 5mm graph paper - how many good ones can you do in a minute?

 

basically anything with small parts that need delicate manipulation will be good for fine motor skills, there are some good toys for this too - try operation where you have to use tweezers to extract body parts without touching the sides, scoobies, that strange elastic character (stretch gordon I think) is good for playing pulling games which can be done with just fingers rather than full grasp. Those mosaic sticker books. French knitting (with a cotton reel) is tricky to learn but satisfying.

 

try ten mins morning and evening and vary the activities so boredom doesn't set in. Once an activity is set up it can be repeated over and over with very little input so you don't need to sit with them all the time but joining in helps make it more fun.

 

we had a four year wait for OT, if I'd known that all we'd get was a list of exercises and a pat on the back I'd just have looked up the exercises and got on with it myself well before then.

 

Zemanski

 

almost forgot - many ASD kids have something called 'lax muscles' or 'elastic joints' where the muscles are too elastic to support the joints properly, often in their hands in particular. Nemo and Com can both bend finger joints back to right angles

it is also a feature of dyspraxia.

Dyspraxia doesn't necessarily show in every aspect of a child's physical presentation, I know twin girls who are very physical and the dyspraxia only affects their speech - they have verbal dyspraxia.

 

one of the points of doing repeated exercise is to help the brain develop efficient synaptic pathways - with dyspraxia the pathways are not trimmed as effectively as in non-dyspraxic children so they are inefficient, over-learning through repetition gives the brain a better chance of sorting this out and making the connections - and yes, this is well documented for dyspraxia, Malika

Edited October 16, 2005 by Zemanski

[seeking-sanity]

Hi Waccoe

 

Just wanted to say this sounded so like my son when he was younger, J's 11 now and was only dx wtih aspergers and dyspraxia earlier this year and I disputed dyspraxia as he is very good at sports, but J has fine motor difficulties and although he now sees the OT it was the ed phsch that origannally did the tests and found out about his dyspraxia and she was the one that referred J to the Ot and this took approx 3 months and although hes only being seeing her for a couple of months the approvement with writing, dressing etc is unbelievable, so keep pushing I wish we had when he was a lot younger.

[smallworld]

thanks everybody, there's some really good advice and ideas,

 

wac

[elainem]

Waccoe,

 

I just remembered another exercise that OT gave us for better handwriting, have to say had forgotten myself to use it but will start now! so many bloomin things to remember Anyhow, she suggested the child lies on the floor to write and as their arm is resting on the floor this foreces them to write with just their hand rather than whole arm. My ds does write with whole arm and that is why control is poor. Also, we use a sloping board at school.

 

Zemanski, I wll def be using some of your ideas, thanks.

Elaine

[Malika]

Thanks Zemanski,

 

for yours ideas and comments my son has low muscles tone and flexible joints as well as one hand folding (the right one) in 2 parts instead of 3 because he has only 2 lines instead of 3 in his palm, that is why I wanted him tested for Fragile X.

Found that he learned a lot writting on the mouse pad as now he is more able to put less pressure on the paper. Writting on the floor is a good idea Elain I do it often with my son but I did not know it could be an OT exercise I just do it when he is tired and do not seem to cope with his own body weight..

 

Malika.

[BusyLizzie100]

Hi all, both my lads have OT for dyspraxia, or DCD, or basically poor gross and fine motor skills. They also have Sensory Integration Dysfunction, so for the younger one he just can't register how much pressure to apply when holding a pencil or putting it to paper.

 

We've had various OT input - motivation is the biggest prob. All very well getting exercises to carry out at home, if you can get your kid to want to do it. Make it as fun as possible! Zemanski's ideas re pegs etc was packaged to us as a 'hand gym' - ie, stuff that gives your hands a workout. Twisting, pulling, rolling play dough was another exercise. The eldest has 'done' the Teodorescu Motor-Perceptuo writing programme, but to no avail. The youngest was at the time unable to even hold a pencil, so although he was given it it do it still lies untouched in a drawer.

 

One of the best pieces of advice (apart from desk and seat at appropriate heights, feet flat on floor, elbows at right angles to body; sloping surface; triangular pencils/pens - Berol handhuggers are good) was to write/draw/squiggle with a short stump of chalk on a blackboard, ideally so that the hand is above shoulder height. Or a pen on a wipeboard. It encourages good posture and grip and, once that is mastered, the kid can then move on to trying to do it on a flat or sloping surface, eg a desk.

 

Encouraging fine motor skills are all very well, but the gross motor skills need to be in place first. As such, my youngest, nearly six, is about to be given exercises to 'strengthen his upper limbs'; I remember my eldest being given similar exercises at an early age - things like crawling races, or walking on hands and feet, cartwheel races, lying on his stomach propped up on his arms to read/watch telly whatever, pushing his kid brother's buggy, even pushing against a wall with his arms. Has it helped him? Dunno - he's nearly eight and his writing is still illegible but I don't know what he'd be like without having done it!

 

My major bones of contention are:

1. The long waiting list for OT input (we were lucky: less than a year. Keep ringing to see where you are on the list)

2. The OT input is finite, ie you get a number of sessions (four or five) and then you're discharged. Ours has only continued because I keep ringing them up with further issues!

3. It's all very well being given an exercise programme to do at home, but the kids have got to want to do them - and mums and dads aren't therapists!

4. What's the use in the OT doing a school visit (bless her) when the school takes no notice of what they advise?

 

Sorry to go on - does this help at all? We get to be such experts in our specialised subjects, don't we!!!!

 

Lizzie

[Malika]

Hi Lizzie Waccoe and all

 

Agree with you OT is an issue because our children need it and there are no provision My son has been assessed in two 45 mn session then discharge with a programe to give to the school who does not want to know, now I find it very difficult to have it done at home because after school he is tired and I am not confident with the exercise given certain are fine but some you really I have to make sure he is placing his feet or hands properly and with my memory pb I cannot remember, to go back there will probably take 4 months.

I really feel let down with this.

My son is eight and is writting is not too bad because he is a perfectionist but not to mention the amount of time he needs to get there. Beside I feel there are other issues mainly sensory integration and processing information awarness of the body in space connected to eye sight, hearing, balance for me they are the main reason why those children do not develope adequate muscle tone (I may be wrong) but where my son has been assessed the OT did not have a clue of ASD children typical problems

However try the mouse pad for hand writting this really work for mine even if he is still completly exhausted after any kind of writing exercise.

 

Spot on on this parents are more and more becoming super expert.

 

Malika.

[UltraMum]

but when he's walking his fingers are pointing out but not in the same direction.

 

Hi Waccoe - the above is a classic sign for developmental dyspraxia - J was diagnosed with this as one of his labels before we got the ASD one which seems to cover allsorts!

 

There's a lady in our LEA who is excellent with this - can come in and give input into the problem with exercises for the LSA to perform etc. I'll PM you with her name.

 

Don't get too excited about the hospital - a year's wait our paediatrician was told ...

[Zemanski]

dyspraxia is one of the comorbid conditions associated with ASDs - that is it often goes with the ASD but is not the main condition for the child. Dyspraxia can be a condition in its own right or it may run alongside others such as dyslexia or ADHD too.

 

with AS kids, particularly those who mask other differences, it is often the physical side, ie the dyspraxia, that is noticed first so it seems quite common to get a diagnosis of dyspraxia and then a couple of years later have the AS confirmed and the dyspraxia sidelined as just part of the overall picture.

 

the muscle tone problems are not only to do with lack of exercise, many dyspraxic children run full tilt at life and are constantly exercising but still have poor muscle tone - obviously lack of exercise can make this worse but exercise will not cure it.

 

what exercise really helps with in dyspraxia is the building of the synaptic pathways to make them more efficient and this takes constant repetition which is why 10mins a day is always better for things like handwriting and OT than 2 hours once a week. I had a class once with 5 children with diagnosed motor problems, not all dyspraxic but most, so I did handwriting daily for that class at registration, the other kids had the best handwriting in the school and the dyspraxic kids were getting the support they needed so everyone was happy.

 

writing schemes like teodorescu are very effective for some children but they don't cure the problem and need to be seen more as a way to help a child practise the skills they need, even if they are not making a disernable difference they may be supporting some of the early skills your child needs. I like teodorescu and have used it successfully with several children but like all strategies it is not necessarily right for every child.

 

if your child has dyspraxia then handwriting will probably always be difficult. However, I would recommend a more holistic approach than focusing only on the hands, developing balance and posture can also influence how a child writes so I would say you need to help with these things too - plenty of trips to playgrounds, trampolines, balance boards (Ikea does a great seat with a curved base) swings, roundabous, martial arts (particularly tae kwondo which is pattern based), swimming, scooters, bikes, skates ......

all these activities help promote an awareness of where the body is in space and help the mind control the body more effectively

 

and most of them are more fun than handwriting!

 

Zemanski

 

just remembered - have a look at the yoropen - Dot has found it fantastic, she can't pick it up wrong and even I can't put pressure on when I try to without a lot of effort

her teacher likes it so much she uses one now.

 

http://www.yoropen.com

 

available on line or from WHsmith

Edited October 21, 2005 by Zemanski

[UltraMum]

Yes - J did all sorts with this lady - more than just exercise- mainly co-ordination etc - his favourite was a low trolley on wheels which he had to lay on, with his feet sticking out the end, so he was having to keep his legs straight and supported, and then he had to use his arms to scoot along the school hall - he had to use each arm equally as otherwise he went off at a tangent!

 

He liked it so much we got one made by a friend for him to use at home - tends to ram into doorways though!

Edited October 21, 2005 by MotherEve